HomeMy WebLinkAboutHetzer ` 4
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971 •
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Fax (516) 765-1823
MARRIAGE OFFICER ® ®� •
4 -prr•� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2009-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HETZER, FRANK JR.
Mailing Address 1 535 MEADOW LANE -
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 535 MEADOW LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5079
Tax Map No. section 116.00 block 2 lot 20.000
Cross Street CASE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/02/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •cuFFO(.,('��'
Town of Southold 0QG•_ Application No.P00 �f
Judith T. Terry, Town Clerk
Town Hall, 53095 Main RoadC74 $10.00 - Residential
P. O. Box 1179 �� $25.00 - Non-Residential
Southold, New York 11971 %O 4 I`,
Telephone441%
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
RECEIVED
• - - - - -- - for - -
NOV 1992
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Southold Town Clerk
Operation Permit No.
Fee $ •
DATE
OWNER NAME: k tJ c ,e,
• OWNER MAILING ADDRESS: 535 ln&/}-Do W ko-nr�
OWNER PROPERTY ADDRESS: S camnQ. -
OWNER TELEPHONE NUMBER: 7 3 L.. ` 5o 7 7
TAX MAP NO. : Section )/(0 Block a Lot a o
CROSS STREET: l.. A-S E. R 04
TYPE- OF SYSTEM: Septic-Tank New Existing
Cesspool V'- New Existing ►-'
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: /0/45,=IN
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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Signature of •:
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